Provider First Line Business Practice Location Address:
255 EAST GROVE STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-936-2960
Provider Business Practice Location Address Fax Number:
570-936-2961
Provider Enumeration Date:
06/28/2018