Provider First Line Business Practice Location Address:
263 CARBONDALE RD
Provider Second Line Business Practice Location Address:
BOX Z
Provider Business Practice Location Address City Name:
WAYMART
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-488-5444
Provider Business Practice Location Address Fax Number:
570-488-6666
Provider Enumeration Date:
09/14/2006