Provider First Line Business Practice Location Address:
615 JEFFERSON AVENUE, SUITE 204
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:
18510-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-1186
Provider Business Practice Location Address Fax Number:
570-344-7641
Provider Enumeration Date:
08/22/2023