Provider First Line Business Practice Location Address:
327 N WASHINGTON AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18503-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-5522
Provider Business Practice Location Address Fax Number:
570-207-5579
Provider Enumeration Date:
05/31/2005