Provider First Line Business Practice Location Address:
153 TERRACE 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:
18407-2669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-494-7014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2019