Provider First Line Business Practice Location Address:
68 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-242-1446
Provider Business Practice Location Address Fax Number:
717-242-1447
Provider Enumeration Date:
02/02/2007