Provider First Line Business Practice Location Address:
8183 ROUTE 522
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
MIDDLEBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17842-9406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-765-7085
Provider Business Practice Location Address Fax Number:
570-765-7086
Provider Enumeration Date:
02/27/2007