Provider First Line Business Practice Location Address:
627 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17512-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-684-2648
Provider Business Practice Location Address Fax Number:
717-684-7989
Provider Enumeration Date:
08/23/2005