Provider First Line Business Practice Location Address:
538 VENARD RD
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:
18411-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-585-9326
Provider Business Practice Location Address Fax Number:
570-585-9336
Provider Enumeration Date:
07/20/2006