Provider First Line Business Practice Location Address:
301 W GROVE ST (BOX 3)
Provider Second Line Business Practice Location Address:
BLDG 2, 2ND FL
Provider Business Practice Location Address City Name:
CLARKS SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-2090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-357-5985
Provider Business Practice Location Address Fax Number:
570-587-5224
Provider Enumeration Date:
02/07/2007