Provider First Line Business Practice Location Address:
4233 OREGON PIKE
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:
17522-9450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-859-4222
Provider Business Practice Location Address Fax Number:
717-859-1562
Provider Enumeration Date:
07/29/2005