Provider First Line Business Practice Location Address:
BOX 120 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-222-5200
Provider Business Practice Location Address Fax Number:
570-222-5201
Provider Enumeration Date:
10/24/2006