Provider First Line Business Practice Location Address:
100 S FIRST STREET
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
MILLERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17061-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-692-4708
Provider Business Practice Location Address Fax Number:
717-692-5464
Provider Enumeration Date:
06/14/2010