Provider First Line Business Practice Location Address:
227 STEPHEN 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:
18505-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-591-6610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2025