Provider First Line Business Practice Location Address:
1032 N WASHINGTON 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:
18509-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-770-5979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2020