Provider First Line Business Practice Location Address:
136 LAKE ST
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:
17522-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-733-9090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2006