Provider First Line Business Practice Location Address:
101 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17222-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-352-7723
Provider Business Practice Location Address Fax Number:
717-352-8302
Provider Enumeration Date:
01/25/2006