Provider First Line Business Practice Location Address:
SOUTH 7TH ST.
Provider Second Line Business Practice Location Address:
HC 63 BOX 7D
Provider Business Practice Location Address City Name:
MIFFLINTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-436-2111
Provider Business Practice Location Address Fax Number:
717-436-0200
Provider Enumeration Date:
04/18/2007