Provider First Line Business Practice Location Address:
2741 BOULEVARD 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:
18509-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-6121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2014