Provider First Line Business Practice Location Address: 
3503 YORK ROAD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
FURLONG
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
18925
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
215-794-5002
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/23/2007