Provider First Line Business Practice Location Address:
141 SALEM AVE
Provider Second Line Business Practice Location Address:
RM 301
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:
570-282-6928
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2008