Provider First Line Business Practice Location Address:
107 KINSLEY 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:
18322-7800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-1658
Provider Business Practice Location Address Fax Number:
570-992-1668
Provider Enumeration Date:
12/16/2020