Provider First Line Business Practice Location Address:
1386 OLD FREEPORT RD
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15238-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-444-3413
Provider Business Practice Location Address Fax Number:
717-444-3421
Provider Enumeration Date:
08/17/2006