Provider First Line Business Practice Location Address:
101 INDEPENDENCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPPENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17257-8238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-658-5626
Provider Business Practice Location Address Fax Number:
717-532-9308
Provider Enumeration Date:
04/17/2006