Provider First Line Business Practice Location Address:
99 N CHURCH 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:
18407-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-281-6141
Provider Business Practice Location Address Fax Number:
570-281-3903
Provider Enumeration Date:
09/27/2006