Provider First Line Business Practice Location Address:
401 ADAMS AVE
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18510-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-4327
Provider Business Practice Location Address Fax Number:
570-344-7822
Provider Enumeration Date:
12/03/2008