Provider First Line Business Practice Location Address:
5351 LINCOLN HWY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GAP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17527-9468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-442-5647
Provider Business Practice Location Address Fax Number:
717-442-0843
Provider Enumeration Date:
11/15/2006