Provider First Line Business Practice Location Address:
1890 STATE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PETERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-396-0330
Provider Business Practice Location Address Fax Number:
805-550-1217
Provider Enumeration Date:
11/03/2006