Provider First Line Business Practice Location Address:
179 CRAWFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15333-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-267-4919
Provider Business Practice Location Address Fax Number:
724-267-4907
Provider Enumeration Date:
02/04/2008