Provider First Line Business Practice Location Address:
399 GREEN AVE EXT STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-280-6456
Provider Business Practice Location Address Fax Number:
717-323-1748
Provider Enumeration Date:
10/16/2020