Provider First Line Business Practice Location Address:
201 LACKAWANNA AVE STE 316
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:
18503-1953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-766-0772
Provider Business Practice Location Address Fax Number:
570-866-3518
Provider Enumeration Date:
12/23/2020