Provider First Line Business Practice Location Address:
201 SMALLACOMBE DRIVE
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:
18508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-348-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2015