Provider First Line Business Practice Location Address:
4000 VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17057-3565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-944-9814
Provider Business Practice Location Address Fax Number:
717-944-9814
Provider Enumeration Date:
12/04/2006