Provider First Line Business Practice Location Address:
743 JEFFERSON AVE STE 104
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:
18510-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-5253
Provider Business Practice Location Address Fax Number:
570-342-6038
Provider Enumeration Date:
07/04/2006