Provider First Line Business Practice Location Address:
1736 SANDERSON 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:
18509-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-5761
Provider Business Practice Location Address Fax Number:
570-961-3355
Provider Enumeration Date:
05/04/2007