Provider First Line Business Practice Location Address:
387 N 9TH 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:
18504-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-3326
Provider Business Practice Location Address Fax Number:
570-969-4210
Provider Enumeration Date:
02/17/2008