Provider First Line Business Practice Location Address:
RT 209 BOX 319
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:
18322-0319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-5454
Provider Business Practice Location Address Fax Number:
570-992-4466
Provider Enumeration Date:
12/08/2006