Provider First Line Business Practice Location Address:
3 WALNUT STREET
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-214-3688
Provider Business Practice Location Address Fax Number:
717-214-3689
Provider Enumeration Date:
10/26/2005