Provider First Line Business Practice Location Address:
2150 PORT ROYAL RD
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:
18411-9660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
705-874-6735
Provider Business Practice Location Address Fax Number:
570-587-4676
Provider Enumeration Date:
10/20/2020