Provider First Line Business Practice Location Address:
1200 MARKET STREET
Provider Second Line Business Practice Location Address:
UNIT 17 PMB 286
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-545-9300
Provider Business Practice Location Address Fax Number:
717-540-3700
Provider Enumeration Date:
10/18/2005