Provider First Line Business Practice Location Address:
119 S 5TH ST
Provider Second Line Business Practice Location Address:
APT. D
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-433-6636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2008