Provider First Line Business Practice Location Address:
301 W 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:
18411-2090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-650-8791
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2011