Provider First Line Business Practice Location Address:
143 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17540-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-656-8181
Provider Business Practice Location Address Fax Number:
717-556-0073
Provider Enumeration Date:
07/14/2005