Provider First Line Business Practice Location Address:
201 RIDGE 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:
18411-1053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-755-9464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2026