Provider First Line Business Practice Location Address:
905 US RTE 522
Provider Second Line Business Practice Location Address:
EVANGELICAL MEDICAL BUILDING
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-374-0496
Provider Business Practice Location Address Fax Number:
570-374-3295
Provider Enumeration Date:
02/22/2006