Provider First Line Business Practice Location Address:
507 LINDEN ST
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18503-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-963-6743
Provider Business Practice Location Address Fax Number:
570-963-6617
Provider Enumeration Date:
05/19/2008