Provider First Line Business Practice Location Address: 
4614 WILLIAM PENN HWY
    Provider Second Line Business Practice Location Address: 
FRANKLIN PLAZA SHOPPING CENTER
    Provider Business Practice Location Address City Name: 
MURRYSVILLE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15668-2004
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-733-1414
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/06/2006