Provider First Line Business Practice Location Address:
30 WEST THIRD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-248-6004
Provider Business Practice Location Address Fax Number:
717-248-9210
Provider Enumeration Date:
11/09/2006