Provider First Line Business Practice Location Address:
359 S MOUNTAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE C2
Provider Business Practice Location Address City Name:
MOUTAINTOP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-403-5080
Provider Business Practice Location Address Fax Number:
570-403-5079
Provider Enumeration Date:
05/09/2006