Provider First Line Business Practice Location Address:
138 S EVERETT 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:
18504-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-207-0807
Provider Business Practice Location Address Fax Number:
570-207-4382
Provider Enumeration Date:
05/08/2020