Provider First Line Business Practice Location Address:
1457 ROUTE 209 STE 101A
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:
18322-7153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-4839
Provider Business Practice Location Address Fax Number:
570-992-4840
Provider Enumeration Date:
01/14/2025