Provider First Line Business Practice Location Address:
STATE AND TANNER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMPSONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-535-4519
Provider Business Practice Location Address Fax Number:
717-535-4518
Provider Enumeration Date:
11/17/2006