Provider First Line Business Practice Location Address:
63 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17057-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-388-1058
Provider Business Practice Location Address Fax Number:
717-388-1109
Provider Enumeration Date:
08/03/2006