Provider First Line Business Practice Location Address:
746 JEFFERSON AVE
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:
18510-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-348-7200
Provider Business Practice Location Address Fax Number:
570-348-1710
Provider Enumeration Date:
07/18/2005