Provider First Line Business Practice Location Address:
501 VINE STREET
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:
18509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
187-734-6355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2016