Provider First Line Business Practice Location Address:
98 REITZ BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17837-9206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-4443
Provider Business Practice Location Address Fax Number:
570-523-1855
Provider Enumeration Date:
01/23/2006