Provider First Line Business Practice Location Address:
614 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYKENS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17048-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-365-7777
Provider Business Practice Location Address Fax Number:
717-365-3848
Provider Enumeration Date:
03/09/2006