Provider First Line Business Practice Location Address:
2137 EMBASSY DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17603-2876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-569-8972
Provider Business Practice Location Address Fax Number:
717-569-7762
Provider Enumeration Date:
09/23/2009