Provider First Line Business Practice Location Address:
750 S HUMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17025-2622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-732-5552
Provider Business Practice Location Address Fax Number:
717-728-9501
Provider Enumeration Date:
06/21/2005