Provider First Line Business Practice Location Address:
720 MADISON 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:
18510-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-1115
Provider Business Practice Location Address Fax Number:
570-343-5865
Provider Enumeration Date:
09/21/2005