Provider First Line Business Practice Location Address:
672 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYKENS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17048-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-453-7662
Provider Business Practice Location Address Fax Number:
717-453-7999
Provider Enumeration Date:
07/30/2006