Provider First Line Business Practice Location Address:
419 MARKET STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYKENS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17048-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-453-9355
Provider Business Practice Location Address Fax Number:
717-453-0846
Provider Enumeration Date:
11/29/2006