Provider First Line Business Practice Location Address:
746 JEFFERSON AVE FL 4
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:
18510-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-241-4715
Provider Business Practice Location Address Fax Number:
570-319-9305
Provider Enumeration Date:
08/17/2009