Provider First Line Business Practice Location Address:
632 DAVIS 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:
18505-4666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-969-1838
Provider Business Practice Location Address Fax Number:
570-963-5790
Provider Enumeration Date:
11/07/2006