Provider First Line Business Practice Location Address:
ROUTE 56
Provider Second Line Business Practice Location Address:
BOX 123
Provider Business Practice Location Address City Name:
FISHERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-839-4152
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2006