Provider First Line Business Practice Location Address:
1032 N WASHINGTON AVE
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:
18509-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-8660
Provider Business Practice Location Address Fax Number:
570-558-6147
Provider Enumeration Date:
04/03/2006