Provider First Line Business Practice Location Address:
29 N MARKET ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-716-0939
Provider Business Practice Location Address Fax Number:
570-507-8463
Provider Enumeration Date:
10/02/2006