Provider First Line Business Practice Location Address:
129 LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17023-8727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-362-1288
Provider Business Practice Location Address Fax Number:
717-362-1287
Provider Enumeration Date:
06/12/2007