Provider First Line Business Practice Location Address:
27 SANDY LANE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-242-2731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007