Provider First Line Business Practice Location Address:
626 S PEACH ALY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17022-2578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-367-6224
Provider Business Practice Location Address Fax Number:
717-367-6580
Provider Enumeration Date:
11/29/2006