Provider First Line Business Practice Location Address:
531 MT PLEASANT DR
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:
18503-1987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-703-2135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2018