Provider First Line Business Practice Location Address:
82 N MAIN ST STE 1
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:
18407-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-282-0200
Provider Business Practice Location Address Fax Number:
570-282-2229
Provider Enumeration Date:
08/29/2019