Provider First Line Business Practice Location Address:
9320 ROUTE 75 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WATERFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17021-0096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-734-3959
Provider Business Practice Location Address Fax Number:
717-734-9599
Provider Enumeration Date:
07/14/2005