Provider First Line Business Practice Location Address:
790 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
CLARKS SUMMIT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-1087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-4141
Provider Business Practice Location Address Fax Number:
570-586-6722
Provider Enumeration Date:
08/04/2006