Provider First Line Business Practice Location Address:
2071 ROUTE 209
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:
18322-7754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-6720
Provider Business Practice Location Address Fax Number:
570-992-6736
Provider Enumeration Date:
06/04/2013