Provider First Line Business Practice Location Address:
3 WALNUT ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-737-4718
Provider Business Practice Location Address Fax Number:
717-909-0902
Provider Enumeration Date:
03/24/2006