Provider First Line Business Practice Location Address:
229 S 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:
18707-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-474-5958
Provider Business Practice Location Address Fax Number:
570-464-6952
Provider Enumeration Date:
06/02/2011