Provider First Line Business Practice Location Address: 
1 WOODLAND RD
    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: 
19610-1933
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-478-1630
    Provider Business Practice Location Address Fax Number: 
610-478-1620
    Provider Enumeration Date: 
12/30/2005