Provider First Line Business Practice Location Address:
203 GREENWOOD AVE
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
CLARKS SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-319-6441
Provider Business Practice Location Address Fax Number:
570-468-8895
Provider Enumeration Date:
07/11/2012