Provider First Line Business Practice Location Address:
185 FALLBROOK 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:
18407-0514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-282-1732
Provider Business Practice Location Address Fax Number:
570-282-6529
Provider Enumeration Date:
03/21/2006