Provider First Line Business Practice Location Address:
313 MULBERRY 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:
18503-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-232-0699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2011