Provider First Line Business Practice Location Address:
110 SHAFER DR
Provider Second Line Business Practice Location Address:
UNIT 101
Provider Business Practice Location Address City Name:
BRODHEADSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18322-7154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-7800
Provider Business Practice Location Address Fax Number:
570-992-0494
Provider Enumeration Date:
04/03/2006