Provider First Line Business Practice Location Address:
504 MARION LANE
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:
18322-0638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-2373
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006