Provider First Line Business Practice Location Address:
101 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-738-2488
Provider Business Practice Location Address Fax Number:
717-721-9088
Provider Enumeration Date:
08/03/2005