Provider First Line Business Practice Location Address: 
125 NORTH SECOND STREET
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WEST NEWTON
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15089
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-963-4921
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/06/2014