Provider First Line Business Practice Location Address:
2791 S QUEEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLASTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17313-9540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-741-4788
Provider Business Practice Location Address Fax Number:
717-741-5945
Provider Enumeration Date:
09/23/2005