Provider First Line Business Practice Location Address:
501 S 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17512-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-449-5238
Provider Business Practice Location Address Fax Number:
717-449-5241
Provider Enumeration Date:
06/14/2006