Provider First Line Business Practice Location Address:
525 FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-377-0064
Provider Business Practice Location Address Fax Number:
724-377-2119
Provider Enumeration Date:
12/20/2007