Provider First Line Business Practice Location Address:
719 OLDE HICKORY RD STE A
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-4985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-314-9171
Provider Business Practice Location Address Fax Number:
717-208-7348
Provider Enumeration Date:
05/13/2006