Provider First Line Business Practice Location Address:
1890 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PETERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17520-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-220-8255
Provider Business Practice Location Address Fax Number:
717-298-9777
Provider Enumeration Date:
06/03/2026