Provider First Line Business Practice Location Address:
30 N MAIN 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:
18407-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-836-3131
Provider Business Practice Location Address Fax Number:
215-273-5975
Provider Enumeration Date:
07/20/2012