Provider First Line Business Practice Location Address:
310 S MAIN ST STE K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YEAGERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17099-9709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-953-9534
Provider Business Practice Location Address Fax Number:
717-953-9536
Provider Enumeration Date:
11/19/2012