Provider First Line Business Practice Location Address:
1138 W MARKET 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:
18508-1241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-5949
Provider Business Practice Location Address Fax Number:
570-343-2564
Provider Enumeration Date:
10/05/2007