Provider First Line Business Practice Location Address:
113 N MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-374-0202
Provider Business Practice Location Address Fax Number:
570-374-7601
Provider Enumeration Date:
06/24/2005