Provider First Line Business Practice Location Address:
1113 SCOTT ST
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:
18322-7109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-695-2972
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2014