Provider First Line Business Practice Location Address:
10058 S MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SOUTH MOUNTAIN RESTORATION CENTER
Provider Business Practice Location Address City Name:
SOUTH MOUNTAIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17261-0999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-749-3121
Provider Business Practice Location Address Fax Number:
717-749-4071
Provider Enumeration Date:
09/07/2006