Provider First Line Business Practice Location Address:
1059 COLUMBIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17603-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-397-7085
Provider Business Practice Location Address Fax Number:
717-390-2584
Provider Enumeration Date:
11/30/2007