Provider First Line Business Practice Location Address:
871 C WEST KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPPENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-532-7893
Provider Business Practice Location Address Fax Number:
717-532-8521
Provider Enumeration Date:
03/01/2007