Provider First Line Business Practice Location Address:
38 BLACK AVENUE
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-263-8339
Provider Business Practice Location Address Fax Number:
717-264-0045
Provider Enumeration Date:
11/18/2009