Provider First Line Business Practice Location Address:
645 N 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-724-0290
Provider Business Practice Location Address Fax Number:
717-695-6290
Provider Enumeration Date:
03/23/2006