Provider First Line Business Practice Location Address:
301 W GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKS SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-2090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-5669
Provider Business Practice Location Address Fax Number:
570-585-6807
Provider Enumeration Date:
11/10/2009