Provider First Line Business Practice Location Address:
4131A OREGON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-9550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-859-1123
Provider Business Practice Location Address Fax Number:
717-859-2898
Provider Enumeration Date:
08/21/2007