Provider First Line Business Practice Location Address:
RT 115 AND 209 HC2
Provider Second Line Business Practice Location Address:
BOX 1120
Provider Business Practice Location Address City Name:
BROADHEADSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-992-6454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2006