Provider First Line Business Practice Location Address:
685 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:
18707-9603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-868-3527
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2005