Provider First Line Business Practice Location Address:
90 MEDICAL PARK DR
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:
17837-6343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-2722
Provider Business Practice Location Address Fax Number:
570-524-0362
Provider Enumeration Date:
11/14/2005