Provider First Line Business Practice Location Address:
MIDTOWN PLAZA, RT 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:
18322-1089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-402-4001
Provider Business Practice Location Address Fax Number:
570-402-4002
Provider Enumeration Date:
12/14/2006