Provider First Line Business Practice Location Address:
711 E ORANGE 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:
17257-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-279-9127
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2016