Provider First Line Business Practice Location Address:
RT 115 & SWITZGABLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROHEADSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18322-0637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-1234
Provider Business Practice Location Address Fax Number:
570-992-8610
Provider Enumeration Date:
03/27/2008