Provider First Line Business Practice Location Address:
116 LARCH ST STE 300
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:
18509-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-489-5561
Provider Business Practice Location Address Fax Number:
570-489-5563
Provider Enumeration Date:
11/30/2005