Provider First Line Business Practice Location Address:
315 N MAIN AVE
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:
18504-1785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-7272
Provider Business Practice Location Address Fax Number:
570-347-5177
Provider Enumeration Date:
10/11/2006