Provider First Line Business Practice Location Address:
120 S. TAN ST.
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-865-6644
Provider Business Practice Location Address Fax Number:
717-865-7321
Provider Enumeration Date:
10/28/2005