Provider First Line Business Practice Location Address:
685 RED DALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORWIGSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17961-2035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-366-0515
Provider Business Practice Location Address Fax Number:
570-366-0838
Provider Enumeration Date:
10/04/2006