Provider First Line Business Practice Location Address:
129 N WASHINGTON AVE APT 413
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:
18503-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-423-3658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2021