Provider First Line Business Practice Location Address:
1800 MULBERRY 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:
18510-2369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-969-8128
Provider Business Practice Location Address Fax Number:
570-558-7936
Provider Enumeration Date:
11/21/2011