Provider First Line Business Practice Location Address:
1810 PITTSTON AVE REAR
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:
18505-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
272-800-8295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2021