Provider First Line Business Practice Location Address:
475 MORGAN HIGHWAY
Provider Second Line Business Practice Location Address:
CHARLES LUGER BLDG
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-207-7919
Provider Business Practice Location Address Fax Number:
570-963-1953
Provider Enumeration Date:
11/24/2006