Provider First Line Business Practice Location Address:
12 ELEANOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW KINGSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-697-3131
Provider Business Practice Location Address Fax Number:
717-697-4614
Provider Enumeration Date:
08/18/2005