Provider First Line Business Practice Location Address:
100 TERRACE LN
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:
18508-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-341-4659
Provider Business Practice Location Address Fax Number:
570-341-4372
Provider Enumeration Date:
07/01/2005