Provider First Line Business Practice Location Address:
110 W VINE ST
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
SHIREMANSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011-6346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-557-1219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2010