Provider First Line Business Practice Location Address:
722 PITTSTON 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:
18505-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-5419
Provider Business Practice Location Address Fax Number:
570-961-0962
Provider Enumeration Date:
03/19/2007