Provider First Line Business Practice Location Address:
1655 MANHEIM PIKE
Provider Second Line Business Practice Location Address:
SUITE C4 BOX C
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-3061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-569-8058
Provider Business Practice Location Address Fax Number:
717-569-1528
Provider Enumeration Date:
02/12/2010