Provider First Line Business Practice Location Address:
395 BEDFORD ST STE C
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:
18411-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-815-5090
Provider Business Practice Location Address Fax Number:
570-319-9674
Provider Enumeration Date:
10/04/2018