Provider First Line Business Practice Location Address:
PLEASANT VALLEY DRIVE
Provider Second Line Business Practice Location Address:
HC 2 BOX 2029
Provider Business Practice Location Address City Name:
BRODHEADSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18322-9709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-402-0700
Provider Business Practice Location Address Fax Number:
570-992-6780
Provider Enumeration Date:
12/01/2006