Provider First Line Business Practice Location Address:
120 W VALLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17824-9703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-672-2711
Provider Business Practice Location Address Fax Number:
570-672-1311
Provider Enumeration Date:
02/09/2007