Provider First Line Business Practice Location Address: 
1111 LOWRY AVE
    Provider Second Line Business Practice Location Address: 
SUITE 6
    Provider Business Practice Location Address City Name: 
JEANNETTE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15644-3063
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-523-5721
    Provider Business Practice Location Address Fax Number: 
724-527-6188
    Provider Enumeration Date: 
08/28/2006