Provider First Line Business Practice Location Address:
239 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17842-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-837-6285
Provider Business Practice Location Address Fax Number:
570-837-6403
Provider Enumeration Date:
06/15/2005