Provider First Line Business Practice Location Address: 
105 BIERER LN
    Provider Second Line Business Practice Location Address: 
UPPER LEVEL
    Provider Business Practice Location Address City Name: 
UNIONTOWN
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15401-3117
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-439-1088
    Provider Business Practice Location Address Fax Number: 
724-439-1113
    Provider Enumeration Date: 
10/18/2007