Provider First Line Business Practice Location Address:
100 LINCOLN AVE
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:
18407-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-282-6485
Provider Business Practice Location Address Fax Number:
570-281-1256
Provider Enumeration Date:
10/04/2005