Provider First Line Business Practice Location Address:
101 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIFFLINBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17844-9607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-966-3155
Provider Business Practice Location Address Fax Number:
570-966-6901
Provider Enumeration Date:
10/04/2005