Provider First Line Business Practice Location Address:
431 REAR 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:
18504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-880-7614
Provider Business Practice Location Address Fax Number:
570-209-7465
Provider Enumeration Date:
10/22/2014