Provider First Line Business Practice Location Address:
635 N 12TH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-831-8452
Provider Business Practice Location Address Fax Number:
717-510-6704
Provider Enumeration Date:
04/03/2026