Provider First Line Business Practice Location Address: 
938 PENN 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: 
19602-1717
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-478-8088
    Provider Business Practice Location Address Fax Number: 
610-478-4884
    Provider Enumeration Date: 
09/03/2009