Provider First Line Business Practice Location Address:
1025 MONROE 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:
18510-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-623-4390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2025