Provider First Line Business Practice Location Address:
552 N WEBSTER 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:
18510-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-594-6167
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2025