Provider First Line Business Practice Location Address:
100 BROWN ST
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17057-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-388-1059
Provider Business Practice Location Address Fax Number:
717-388-1046
Provider Enumeration Date:
12/08/2009