Provider First Line Business Practice Location Address:
PO BOX 1002
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-738-6618
Provider Business Practice Location Address Fax Number:
717-738-6646
Provider Enumeration Date:
04/08/2011