Provider First Line Business Practice Location Address:
411 S FAYETTE ST
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:
17257-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-530-1698
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2022