Provider First Line Business Practice Location Address:
155 BROOKLYN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-282-3344
Provider Business Practice Location Address Fax Number:
570-282-4622
Provider Enumeration Date:
04/17/2006