Provider First Line Business Practice Location Address:
ROUTE 61 PINEBROOK PLACE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
ORWIGSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17961-0346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-366-3739
Provider Business Practice Location Address Fax Number:
570-366-3708
Provider Enumeration Date:
11/18/2005