Provider First Line Business Practice Location Address:
517 ASH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18509-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-969-6100
Provider Business Practice Location Address Fax Number:
570-969-6161
Provider Enumeration Date:
02/20/2006