Provider First Line Business Practice Location Address: 
420 S 5TH AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WEST READING
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19611-2143
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
484-628-8615
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/09/2006