Provider First Line Business Practice Location Address:
30 EAST SHADY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-732-2222
Provider Business Practice Location Address Fax Number:
717-732-9811
Provider Enumeration Date:
06/27/2006