Provider First Line Business Practice Location Address:
625 WALES 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:
18508-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-407-2783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2025