Provider First Line Business Practice Location Address:
130 BUFFALO RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17837-1159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-5294
Provider Business Practice Location Address Fax Number:
570-577-1957
Provider Enumeration Date:
04/25/2007