Provider First Line Business Practice Location Address:
101 E LOCUST 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-259-7125
Provider Business Practice Location Address Fax Number:
717-259-9399
Provider Enumeration Date:
07/14/2005