Provider First Line Business Practice Location Address:
1750 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-843-7829
Provider Business Practice Location Address Fax Number:
717-854-7718
Provider Enumeration Date:
07/19/2005