Provider First Line Business Practice Location Address:
300 LACKAWANNA 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:
18503-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-3823
Provider Business Practice Location Address Fax Number:
570-207-5988
Provider Enumeration Date:
07/16/2018