Provider First Line Business Practice Location Address: 
4941 CLAIRTON BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PITTSBURGH
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15236-2101
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-673-2710
    Provider Business Practice Location Address Fax Number: 
412-673-9311
    Provider Enumeration Date: 
11/23/2007