Provider First Line Business Practice Location Address: 
1597 WASHINGTON PIKE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BRIDGEVILLE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15017-2874
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-278-1221
    Provider Business Practice Location Address Fax Number: 
412-278-0201
    Provider Enumeration Date: 
08/27/2005