Provider First Line Business Practice Location Address:
21 S CHUCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUARRYVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17566-0487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-786-4277
Provider Business Practice Location Address Fax Number:
717-786-7624
Provider Enumeration Date:
09/07/2005