Provider First Line Business Practice Location Address:
115 SHIPTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIFFLINBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17844-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-966-8336
Provider Business Practice Location Address Fax Number:
570-966-8339
Provider Enumeration Date:
05/19/2006