Provider First Line Business Practice Location Address:
650 N SOUTH RD
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:
18504-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-348-5372
Provider Business Practice Location Address Fax Number:
570-348-1030
Provider Enumeration Date:
03/30/2007