Provider First Line Business Practice Location Address:
20 ARDMORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMMELSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17036-9251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-566-6716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2005