Provider First Line Business Practice Location Address:
425 S MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16662-1053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-793-2104
Provider Business Practice Location Address Fax Number:
814-793-5230
Provider Enumeration Date:
09/03/2009