Provider First Line Business Practice Location Address:
130 S PENN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHEIM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17545-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-665-2496
Provider Business Practice Location Address Fax Number:
717-665-6345
Provider Enumeration Date:
11/30/2005