Provider First Line Business Practice Location Address:
975 WHEELER 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:
18510-1485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-1936
Provider Business Practice Location Address Fax Number:
570-961-5908
Provider Enumeration Date:
08/11/2009