Provider First Line Business Practice Location Address:
441 WYOMING AVE REAR
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:
18503-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-209-9519
Provider Business Practice Location Address Fax Number:
272-249-2491
Provider Enumeration Date:
02/26/2026