Provider First Line Business Practice Location Address:
EAATS-M
Provider Second Line Business Practice Location Address:
CARE OF DMVA
Provider Business Practice Location Address City Name:
ANNVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17003-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-861-9175
Provider Business Practice Location Address Fax Number:
717-861-8235
Provider Enumeration Date:
02/20/2007