Provider First Line Business Practice Location Address:
127 N MAIN 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:
18504-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-9352
Provider Business Practice Location Address Fax Number:
570-342-1338
Provider Enumeration Date:
01/30/2006