Provider First Line Business Practice Location Address:
204 S MAIN ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15722-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-458-1155
Provider Business Practice Location Address Fax Number:
800-958-2475
Provider Enumeration Date:
04/20/2011