Provider First Line Business Practice Location Address:
2 GREENFIELD RD
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:
18407-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-281-9776
Provider Business Practice Location Address Fax Number:
570-282-5653
Provider Enumeration Date:
01/14/2014