Provider First Line Business Practice Location Address:
1248 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-332-2675
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2015