Provider First Line Business Practice Location Address:
236 MANOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17551-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-872-5448
Provider Business Practice Location Address Fax Number:
717-872-5617
Provider Enumeration Date:
06/30/2005