Provider First Line Business Practice Location Address:
217 S STATE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-587-3828
Provider Business Practice Location Address Fax Number:
570-587-5266
Provider Enumeration Date:
12/28/2006