Provider First Line Business Practice Location Address:
3771 PETERS MOUNTAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALIFAX
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17032-8605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-896-7612
Provider Business Practice Location Address Fax Number:
717-896-7617
Provider Enumeration Date:
03/31/2006