Provider First Line Business Practice Location Address:
100 E 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:
18411-1774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-1961
Provider Business Practice Location Address Fax Number:
570-587-0319
Provider Enumeration Date:
10/10/2005