Provider First Line Business Practice Location Address:
1408 EAST CARSON ST
Provider Second Line Business Practice Location Address:
SOUTH SIDE DENTAL PAVILION
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-431-6631
Provider Business Practice Location Address Fax Number:
412-431-6297
Provider Enumeration Date:
02/26/2008