Provider First Line Business Practice Location Address:
101 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17976-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-462-1908
Provider Business Practice Location Address Fax Number:
570-462-1457
Provider Enumeration Date:
06/01/2005