Provider First Line Business Practice Location Address:
1101 MOOSIC ST
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:
18505-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-347-6991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2010