Provider First Line Business Practice Location Address:
803 S MAIN 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:
18504-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-8166
Provider Business Practice Location Address Fax Number:
855-429-2485
Provider Enumeration Date:
04/22/2015