Provider First Line Business Practice Location Address:
125 NORTH CENTER ST
Provider Second Line Business Practice Location Address:
BOX 506
Provider Business Practice Location Address City Name:
GRATZ
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17030-0506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-365-4052
Provider Business Practice Location Address Fax Number:
717-365-3858
Provider Enumeration Date:
02/10/2017