Provider First Line Business Practice Location Address:
327 N WASHINGTON AVE STE 104
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:
18503-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-3361
Provider Business Practice Location Address Fax Number:
570-961-3364
Provider Enumeration Date:
09/22/2022