Provider First Line Business Practice Location Address:
110 N 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:
18707-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-261-7792
Provider Business Practice Location Address Fax Number:
570-261-4544
Provider Enumeration Date:
12/05/2022