Provider First Line Business Practice Location Address:
REAR TRAPP PLAZA
Provider Second Line Business Practice Location Address:
RTE.#6, SCRANTON/CARBONDALE HWY.
Provider Business Practice Location Address City Name:
ARCHBALD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-876-6626
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2005