Provider First Line Business Practice Location Address:
1303 OAKMONT 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:
18411-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-587-1699
Provider Business Practice Location Address Fax Number:
579-587-1532
Provider Enumeration Date:
06/11/2013