Provider First Line Business Practice Location Address:
191 RIDGEVIEW RD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-367-2212
Provider Business Practice Location Address Fax Number:
717-367-3772
Provider Enumeration Date:
05/04/2015