Provider First Line Business Practice Location Address:
104 FITE WAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
QUARRYVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17566-9395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-786-8896
Provider Business Practice Location Address Fax Number:
717-786-8367
Provider Enumeration Date:
10/15/2005