Provider First Line Business Practice Location Address:
401 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870-1153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-374-1144
Provider Business Practice Location Address Fax Number:
570-372-2222
Provider Enumeration Date:
10/12/2006