Provider First Line Business Practice Location Address:
148 FAIRFIELD ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-9986
Provider Business Practice Location Address Fax Number:
570-524-9973
Provider Enumeration Date:
05/17/2006