Provider First Line Business Practice Location Address: 
201 REECEVILLE RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
COATESVILLE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19320-1542
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-383-8000
    Provider Business Practice Location Address Fax Number: 
610-383-8360
    Provider Enumeration Date: 
01/31/2006