Provider First Line Business Practice Location Address: 
543 ELM ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
READING
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19601-3386
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
610-396-9900
    Provider Business Practice Location Address Fax Number: 
610-396-9901
    Provider Enumeration Date: 
02/26/2015