Provider First Line Business Practice Location Address:
638 FAIRVIEW RD
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:
18411-8955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-281-1315
Provider Business Practice Location Address Fax Number:
570-281-1256
Provider Enumeration Date:
08/22/2006