Provider First Line Business Practice Location Address:
1050 NORTHERN BOULEVARD
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:
18411-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-587-4508
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2007