Provider First Line Business Practice Location Address: 
143 SWEITZER DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
DUKE CENTER
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16729-9507
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
814-817-1380
    Provider Business Practice Location Address Fax Number: 
814-966-3911
    Provider Enumeration Date: 
03/11/2016