Provider First Line Business Practice Location Address:
1126 W 4TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-641-4327
Provider Business Practice Location Address Fax Number:
814-641-7104
Provider Enumeration Date:
10/14/2025