Provider First Line Business Practice Location Address:
1439 CENTRE TPKE
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:
17961-9066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-366-1014
Provider Business Practice Location Address Fax Number:
570-366-3894
Provider Enumeration Date:
07/31/2006