Organization
ILUMINA LIFE CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELODY COOPER (CEO)
(814) 467-4055
Entity
Organization
Contact information
Practice address
418 N LOGAN BLVD, SUITE B, BURNHAM, PA 17009-1816
(717) 242-3900
(717) 248-8590
Mailing address
136 JAYCEE DR, SUITE 10, JOHNSTOWN, PA 15904-3650
(814) 467-4055
(814) 262-8161
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
MD423112
PA
Other
Enumeration date
08/04/2015
Last updated
08/04/2015
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