Provider First Line Business Practice Location Address:
1001 WHEELER 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:
18510-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-839-7005
Provider Business Practice Location Address Fax Number:
570-839-7004
Provider Enumeration Date:
04/10/2006