Provider First Line Business Practice Location Address:
115 E. GROVE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-1188
Provider Business Practice Location Address Fax Number:
570-585-7323
Provider Enumeration Date:
11/29/2006