Provider First Line Business Practice Location Address:
120 WEST WATER STREET
Provider Second Line Business Practice Location Address:
BOX 160
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-944-3201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2006