Provider First Line Business Practice Location Address:
22 CHURCH 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:
18707-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-266-9842
Provider Business Practice Location Address Fax Number:
570-474-9836
Provider Enumeration Date:
11/21/2011