Provider First Line Business Practice Location Address:
201 HUDSON AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-0690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2007