Provider First Line Business Practice Location Address:
1017 MUMMA ROAD
Provider Second Line Business Practice Location Address:
SUIT 200
Provider Business Practice Location Address City Name:
WORMLEYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-303-5960
Provider Business Practice Location Address Fax Number:
717-303-5962
Provider Enumeration Date:
05/23/2007