Provider First Line Business Practice Location Address:
116 N STATE 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:
18411-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-587-4031
Provider Business Practice Location Address Fax Number:
570-587-8823
Provider Enumeration Date:
02/10/2006