Provider First Line Business Practice Location Address:
250 N LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHAEFFERSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-949-6963
Provider Business Practice Location Address Fax Number:
717-949-8013
Provider Enumeration Date:
08/10/2005