Provider First Line Business Practice Location Address:
1604 EVANS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKEESPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-675-5076
Provider Business Practice Location Address Fax Number:
412-675-5072
Provider Enumeration Date:
08/09/2006