Provider First Line Business Practice Location Address:
20 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17057-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-343-3075
Provider Business Practice Location Address Fax Number:
717-260-3038
Provider Enumeration Date:
10/22/2012