Provider First Line Business Practice Location Address:
314 S IRVING AVE
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:
18505-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-2755
Provider Business Practice Location Address Fax Number:
570-562-2435
Provider Enumeration Date:
01/10/2006