Provider First Line Business Practice Location Address:
829 SCRANTON CARBONDALE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EYNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18403-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-383-7502
Provider Business Practice Location Address Fax Number:
866-600-7413
Provider Enumeration Date:
04/17/2015