Provider First Line Business Practice Location Address:
67 W KING ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SHIPPENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17257-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-530-1698
Provider Business Practice Location Address Fax Number:
717-530-5186
Provider Enumeration Date:
07/22/2005