Provider First Line Business Practice Location Address:
267 BROOKLYN STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-282-1240
Provider Business Practice Location Address Fax Number:
570-282-7937
Provider Enumeration Date:
11/21/2007