Provider First Line Business Practice Location Address:
407 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:
18411-1061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-9500
Provider Business Practice Location Address Fax Number:
570-586-9485
Provider Enumeration Date:
01/12/2006