Provider First Line Business Practice Location Address:
300 LACKAWANNA AVE STE 200
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:
18503-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-6986
Provider Business Practice Location Address Fax Number:
570-348-6795
Provider Enumeration Date:
10/20/2023