Provider First Line Business Practice Location Address:
RTE. 209
Provider Second Line Business Practice Location Address:
HC#1 BOX 110
Provider Business Practice Location Address City Name:
BRODHEADSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18322-9532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-4400
Provider Business Practice Location Address Fax Number:
570-992-5262
Provider Enumeration Date:
01/26/2006