Provider First Line Business Practice Location Address: 
145 N 6TH ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
READING
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19601
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-378-2440
    Provider Business Practice Location Address Fax Number: 
610-378-2441
    Provider Enumeration Date: 
10/28/2008