Provider First Line Business Practice Location Address:
442 N MAIN 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:
18504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-347-5605
Provider Business Practice Location Address Fax Number:
570-347-5606
Provider Enumeration Date:
08/29/2006