Provider First Line Business Practice Location Address:
428 SPRUCE STREET
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:
18503-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-346-1771
Provider Business Practice Location Address Fax Number:
570-346-5812
Provider Enumeration Date:
02/14/2008