Provider First Line Business Practice Location Address:
329 PENN AVE STE 202
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:
18503-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-4665
Provider Business Practice Location Address Fax Number:
570-342-5024
Provider Enumeration Date:
04/21/2006