Provider First Line Business Practice Location Address:
141 SALEM AVE STE 302
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:
18407-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-282-2031
Provider Business Practice Location Address Fax Number:
570-282-2534
Provider Enumeration Date:
02/09/2006