Provider First Line Business Practice Location Address:
1021 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:
18505-4550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-3361
Provider Business Practice Location Address Fax Number:
570-836-7609
Provider Enumeration Date:
02/20/2009