Provider First Line Business Practice Location Address:
1023 MUMMA RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-724-4672
Provider Business Practice Location Address Fax Number:
717-724-4689
Provider Enumeration Date:
01/04/2006