Provider First Line Business Practice Location Address:
645 N 12TH ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-919-1845
Provider Business Practice Location Address Fax Number:
717-296-0716
Provider Enumeration Date:
07/02/2007