Provider First Line Business Practice Location Address:
1547 DICKENS ST
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:
18504-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-499-4157
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2020