Provider First Line Business Practice Location Address:
219 N MAIN AVE # 152
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:
18504-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-731-3200
Provider Business Practice Location Address Fax Number:
570-343-2401
Provider Enumeration Date:
08/27/2021