Provider First Line Business Practice Location Address:
1027 MOOSIC ST
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:
18505-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-341-9570
Provider Business Practice Location Address Fax Number:
570-341-5318
Provider Enumeration Date:
12/28/2006