Provider First Line Business Practice Location Address:
700 SOUTH STATE STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CLARKS SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-309-6199
Provider Business Practice Location Address Fax Number:
800-746-0578
Provider Enumeration Date:
01/03/2017