Provider First Line Business Practice Location Address:
1198 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18706-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2007