Provider First Line Business Practice Location Address:
508 GRANDVIEW 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:
18411-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-815-2132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2014