Provider First Line Business Practice Location Address:
1818 WAYNE AVE
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:
18508-2787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-8444
Provider Business Practice Location Address Fax Number:
570-341-2221
Provider Enumeration Date:
07/26/2006