Provider First Line Business Practice Location Address:
430 N MAIN AVE REAR APT 3
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:
18504-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-489-5561
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2025