Provider First Line Business Practice Location Address:
125 LUCY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMMELSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17036-9134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-915-7877
Provider Business Practice Location Address Fax Number:
717-323-6838
Provider Enumeration Date:
09/10/2025