Provider First Line Business Practice Location Address:
41 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:
18407-2357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-3361
Provider Business Practice Location Address Fax Number:
570-961-3364
Provider Enumeration Date:
10/21/2020