Provider First Line Business Practice Location Address:
525 N 12TH ST STE 100
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:
17043-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-730-0733
Provider Business Practice Location Address Fax Number:
717-730-0696
Provider Enumeration Date:
09/21/2006