Provider First Line Business Practice Location Address:
5970 LEMON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PETERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17520-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-239-1570
Provider Business Practice Location Address Fax Number:
717-239-1572
Provider Enumeration Date:
01/22/2008