Provider First Line Business Practice Location Address:
418 W KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17316-9667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-259-9596
Provider Business Practice Location Address Fax Number:
717-259-0703
Provider Enumeration Date:
08/22/2006