Provider First Line Business Practice Location Address: 
5301 GROVE RD
    Provider Second Line Business Practice Location Address: 
SUITE B530
    Provider Business Practice Location Address City Name: 
PITTSBURGH
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15236-1691
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-884-2020
    Provider Business Practice Location Address Fax Number: 
412-885-4331
    Provider Enumeration Date: 
03/06/2007