Provider First Line Business Practice Location Address:
15 S MAIN 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:
17976-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-462-1924
Provider Business Practice Location Address Fax Number:
570-462-1760
Provider Enumeration Date:
05/02/2011