Provider First Line Business Practice Location Address:
201 SMALLACOMBE DR
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:
18508-2616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-0171
Provider Business Practice Location Address Fax Number:
570-207-2411
Provider Enumeration Date:
12/05/2006