Provider First Line Business Practice Location Address:
814 GREEN RIDGE ST
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:
18509-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-316-5085
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2020