Provider First Line Business Practice Location Address: 
500 WALNUT ST
    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: 
15132-2801
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-675-8533
    Provider Business Practice Location Address Fax Number: 
412-675-8920
    Provider Enumeration Date: 
06/25/2012