Provider First Line Business Practice Location Address:
1800 MULBERRY 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:
18510-2369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-703-8259
Provider Business Practice Location Address Fax Number:
570-703-7250
Provider Enumeration Date:
07/03/2006