Provider First Line Business Practice Location Address:
305 MULBERRY STREET
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:
570-909-9972
Provider Business Practice Location Address Fax Number:
570-955-0267
Provider Enumeration Date:
10/26/2009