Provider First Line Business Practice Location Address:
34 NORTH CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-282-1107
Provider Business Practice Location Address Fax Number:
570-282-1108
Provider Enumeration Date:
04/04/2006