Provider First Line Business Practice Location Address:
1075 W KING 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:
17257-7900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-532-3432
Provider Business Practice Location Address Fax Number:
717-532-3492
Provider Enumeration Date:
11/24/2018