Provider First Line Business Practice Location Address:
330 S MAIN 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:
18517-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-341-1429
Provider Business Practice Location Address Fax Number:
570-343-1494
Provider Enumeration Date:
09/29/2011