Provider First Line Business Practice Location Address:
765 FIFTH AVENUE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-446-0895
Provider Business Practice Location Address Fax Number:
717-753-3152
Provider Enumeration Date:
10/10/2005