Provider First Line Business Practice Location Address:
1965 BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17316-9164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-870-4662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2019