Provider First Line Business Practice Location Address:
22 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIFFLINTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17059-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-436-8281
Provider Business Practice Location Address Fax Number:
717-436-5025
Provider Enumeration Date:
11/14/2005