Provider First Line Business Practice Location Address:
1003 PITTSTON 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:
18505-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-1842
Provider Business Practice Location Address Fax Number:
570-343-3597
Provider Enumeration Date:
02/15/2011