Provider First Line Business Practice Location Address:
239 PENNAVENUE FORUM PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-346-6170
Provider Business Practice Location Address Fax Number:
570-346-2575
Provider Enumeration Date:
01/10/2006