Provider First Line Business Practice Location Address:
4910 FAIRFIELD RD STE B
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17320-9510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-642-8812
Provider Business Practice Location Address Fax Number:
717-642-6691
Provider Enumeration Date:
10/17/2006