Provider First Line Business Practice Location Address:
12 CARRIAGE SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOBYHANNA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18466-3960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-894-0571
Provider Business Practice Location Address Fax Number:
570-894-8775
Provider Enumeration Date:
05/24/2011