Provider First Line Business Practice Location Address:
1689 CROWN AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-6314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-468-1130
Provider Business Practice Location Address Fax Number:
717-299-0875
Provider Enumeration Date:
03/27/2008