Provider First Line Business Practice Location Address:
1060 S. STATE STREET
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-738-0588
Provider Business Practice Location Address Fax Number:
717-738-0539
Provider Enumeration Date:
04/19/2013