Provider First Line Business Practice Location Address:
428 S MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16662-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-793-3428
Provider Business Practice Location Address Fax Number:
814-793-3491
Provider Enumeration Date:
11/10/2006