Provider First Line Business Practice Location Address:
42 LOG CABIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17028-8204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-469-0462
Provider Business Practice Location Address Fax Number:
717-469-1406
Provider Enumeration Date:
05/11/2009