Provider First Line Business Practice Location Address:
15 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-273-5992
Provider Business Practice Location Address Fax Number:
717-273-5995
Provider Enumeration Date:
12/19/2006