Provider First Line Business Practice Location Address:
1070 DAIRY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17022-9547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-560-2917
Provider Business Practice Location Address Fax Number:
717-560-2985
Provider Enumeration Date:
07/16/2012