Provider First Line Business Practice Location Address:
1000 ROUTE 522
Provider Second Line Business Practice Location Address:
SELINSGROVE CENTER
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870-8707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-372-5974
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007