Provider First Line Business Practice Location Address:
1130 W 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-247-4327
Provider Business Practice Location Address Fax Number:
717-248-1425
Provider Enumeration Date:
12/29/2006