Provider First Line Business Practice Location Address:
5 MORGAN HWY
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18508-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-7410
Provider Business Practice Location Address Fax Number:
570-207-4287
Provider Enumeration Date:
10/13/2006