Provider First Line Business Practice Location Address:
63 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-280-2414
Provider Business Practice Location Address Fax Number:
570-280-2873
Provider Enumeration Date:
08/09/2016