Provider First Line Business Practice Location Address:
219 W 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:
17540-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-397-1400
Provider Business Practice Location Address Fax Number:
717-556-0149
Provider Enumeration Date:
10/03/2006