Provider First Line Business Practice Location Address:
120 PENN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17752-1144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-547-1608
Provider Business Practice Location Address Fax Number:
717-547-6271
Provider Enumeration Date:
05/19/2006