Provider First Line Business Practice Location Address:
539 LINDEN ST
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:
18503-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-8936
Provider Business Practice Location Address Fax Number:
570-343-1455
Provider Enumeration Date:
08/30/2011