Provider First Line Business Practice Location Address:
3 W OLIVE ST
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:
18508-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-207-4054
Provider Business Practice Location Address Fax Number:
570-207-4057
Provider Enumeration Date:
12/21/2012