Provider First Line Business Practice Location Address:
1056 ROUTE 390
Provider Second Line Business Practice Location Address:
HIGHPOINT BUSINESS CENTER
Provider Business Practice Location Address City Name:
MOUNTAINHOME
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-856-2087
Provider Business Practice Location Address Fax Number:
570-595-0528
Provider Enumeration Date:
05/21/2012