Provider First Line Business Practice Location Address:
10 S MOUNTAIN BLVD
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:
18707-1199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-474-5859
Provider Business Practice Location Address Fax Number:
570-474-9594
Provider Enumeration Date:
11/28/2023