Provider First Line Business Practice Location Address:
1141 MOOSIC ST STE 3
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:
18505-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-451-3404
Provider Business Practice Location Address Fax Number:
570-451-3407
Provider Enumeration Date:
07/09/2019