Provider First Line Business Practice Location Address:
21 EAST MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-656-2586
Provider Business Practice Location Address Fax Number:
717-656-9504
Provider Enumeration Date:
10/02/2006