Provider First Line Business Practice Location Address:
100 COMMUNITY DR
Provider Second Line Business Practice Location Address:
STE. 206 MOUNTAIN HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
TOBYHANNA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18466-8985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-839-3668
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2009