Provider First Line Business Practice Location Address:
RT 209 & WEIR LAKE ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-5114
Provider Business Practice Location Address Fax Number:
570-992-0788
Provider Enumeration Date:
11/26/2018