Provider First Line Business Practice Location Address:
239 NORTHERN BLVD
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:
18411-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-587-2142
Provider Business Practice Location Address Fax Number:
570-587-1978
Provider Enumeration Date:
07/27/2007