Provider First Line Business Practice Location Address:
400 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
CLINICAL NUTRITION SERVICES
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-248-5411
Provider Business Practice Location Address Fax Number:
717-242-7255
Provider Enumeration Date:
12/09/2014