Provider First Line Business Practice Location Address:
121 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:
17316-9728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-259-8056
Provider Business Practice Location Address Fax Number:
717-259-6774
Provider Enumeration Date:
03/31/2006