Provider First Line Business Practice Location Address:
743 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18510-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-0182
Provider Business Practice Location Address Fax Number:
570-558-0183
Provider Enumeration Date:
10/19/2006