Provider First Line Business Practice Location Address:
222 WYOMING 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:
18503-1441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-497-9478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2016