Provider First Line Business Practice Location Address:
13359 FERGUSON VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YEAGERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17099-9682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-242-0522
Provider Business Practice Location Address Fax Number:
717-242-0144
Provider Enumeration Date:
11/01/2006