Provider First Line Business Practice Location Address:
RR 1 BOX 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMPSONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17094-9722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-463-2632
Provider Business Practice Location Address Fax Number:
775-255-4723
Provider Enumeration Date:
10/06/2005