Provider First Line Business Practice Location Address:
1135 OLD WEST CHOCOLATE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HUMMELSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-531-7010
Provider Business Practice Location Address Fax Number:
717-531-7102
Provider Enumeration Date:
03/12/2020