Provider First Line Business Practice Location Address:
2603 STAFFORD 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:
18505-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-5558
Provider Business Practice Location Address Fax Number:
570-558-5557
Provider Enumeration Date:
05/29/2007