Provider First Line Business Practice Location Address:
3123 LINCOLN HWY E
Provider Second Line Business Practice Location Address:
REAR OF BUILDING
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17562-9648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-687-0155
Provider Business Practice Location Address Fax Number:
717-687-0901
Provider Enumeration Date:
08/23/2007