Provider First Line Business Practice Location Address:
204 MIFFLIN 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-3145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006