Provider First Line Business Practice Location Address:
624 W CENTRE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17976-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-671-0300
Provider Business Practice Location Address Fax Number:
570-671-0305
Provider Enumeration Date:
11/16/2010