Provider First Line Business Practice Location Address:
2904 COLLIERY 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:
18505-3165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-878-6537
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2017