Provider First Line Business Practice Location Address:
10 GREEN RIDGE ST STE 2
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:
18509-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-780-8438
Provider Business Practice Location Address Fax Number:
570-347-1534
Provider Enumeration Date:
09/27/2005