Provider First Line Business Practice Location Address:
3317 ROUTE 40
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15333-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-632-5959
Provider Business Practice Location Address Fax Number:
724-632-5919
Provider Enumeration Date:
04/20/2006