Provider First Line Business Practice Location Address:
1871 OLD MAIN 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:
17257-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-477-1458
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2005