Provider First Line Business Practice Location Address:
3059 MOUNTAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAYLORSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18353-7794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-977-0385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2026