Provider First Line Business Practice Location Address:
2232 ROUTE 115
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:
18322-0026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-2377
Provider Business Practice Location Address Fax Number:
570-992-2173
Provider Enumeration Date:
05/24/2006