Provider First Line Business Practice Location Address:
136 A & B LAKE STREET
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:
717-721-7718
Provider Business Practice Location Address Fax Number:
717-721-7726
Provider Enumeration Date:
09/08/2006