Provider First Line Business Practice Location Address:
ROUTE 209
Provider Second Line Business Practice Location Address:
PLEASANT VALLEY HIGH SCHOOL
Provider Business Practice Location Address City Name:
BRODHEADSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18322-9715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-515-6477
Provider Business Practice Location Address Fax Number:
610-515-6457
Provider Enumeration Date:
09/12/2011