Provider First Line Business Practice Location Address:
HC 1 BOX 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRODHEADSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18322-9660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-2929
Provider Business Practice Location Address Fax Number:
570-992-3221
Provider Enumeration Date:
10/17/2006