Provider First Line Business Practice Location Address:
120 BURRUS BLVD
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:
18322-7812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-420-6300
Provider Business Practice Location Address Fax Number:
570-402-2920
Provider Enumeration Date:
11/14/2006