Provider First Line Business Practice Location Address:
718 S STATE 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:
18411-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-2222
Provider Business Practice Location Address Fax Number:
570-585-1321
Provider Enumeration Date:
01/03/2011