Provider First Line Business Practice Location Address:
35 SOUTH MOUNTAIN BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAINTOP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18707-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-474-5978
Provider Business Practice Location Address Fax Number:
570-474-5485
Provider Enumeration Date:
12/10/2007