Provider First Line Business Practice Location Address:
1035 MUMMA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORMLEYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-975-5525
Provider Business Practice Location Address Fax Number:
717-975-8815
Provider Enumeration Date:
09/29/2006