Provider First Line Business Practice Location Address:
1323 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:
18505-1536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-381-6613
Provider Business Practice Location Address Fax Number:
818-937-9684
Provider Enumeration Date:
02/16/2022