Provider First Line Business Practice Location Address:
581 FREEMASON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17022-3187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-367-1121
Provider Business Practice Location Address Fax Number:
717-367-5813
Provider Enumeration Date:
10/30/2012