Provider First Line Business Practice Location Address:
119 S MAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN TOP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18707-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-5571
Provider Business Practice Location Address Fax Number:
570-208-5548
Provider Enumeration Date:
07/26/2010