Provider First Line Business Practice Location Address:
550 N 12TH ST
Provider Second Line Business Practice Location Address:
S 120
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-737-9818
Provider Business Practice Location Address Fax Number:
717-737-2815
Provider Enumeration Date:
08/31/2009