Provider First Line Business Practice Location Address:
4686 RTE 209 LYKENS VALLEY SC
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-362-9018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006