Provider First Line Business Practice Location Address:
18 N MAIN ST
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:
17044-1745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-994-7936
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2008