Provider First Line Business Practice Location Address: 
35 N 3RD ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
OXFORD
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19363-1423
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-998-1807
    Provider Business Practice Location Address Fax Number: 
610-998-1808
    Provider Enumeration Date: 
02/21/2012