Provider First Line Business Practice Location Address: 
401 SHADY AVE
    Provider Second Line Business Practice Location Address: 
SUITE C-107
    Provider Business Practice Location Address City Name: 
PITTSBURGH
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15206-4409
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-361-0222
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/01/2006