Provider First Line Business Practice Location Address:
28190 WILLOW ST PIKE
Provider Second Line Business Practice Location Address:
LIFE SPAN PSYCHOLOGICAL SERVICES PC
Provider Business Practice Location Address City Name:
WILLOW STREET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-464-1464
Provider Business Practice Location Address Fax Number:
717-464-4348
Provider Enumeration Date:
07/06/2006