Provider First Line Business Practice Location Address:
307 VILLAGE EDGE DR
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:
570-992-1011
Provider Business Practice Location Address Fax Number:
570-402-3534
Provider Enumeration Date:
02/13/2006