Provider First Line Business Practice Location Address: 
5396 CLAUSER RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
OREFIELD
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
18069-8941
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
215-208-8141
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/18/2011