Provider First Line Business Practice Location Address:
125 S PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-248-6979
Provider Business Practice Location Address Fax Number:
717-248-6511
Provider Enumeration Date:
07/18/2006