Provider First Line Business Practice Location Address:
320 LOUCKS RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17404-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-650-1398
Provider Business Practice Location Address Fax Number:
717-650-2177
Provider Enumeration Date:
11/02/2008