Provider First Line Business Practice Location Address:
1339 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:
18508-1880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-1444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006