Provider First Line Business Practice Location Address:
409 N MAIN AVE STE 1
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:
18504-1798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-209-7878
Provider Business Practice Location Address Fax Number:
570-209-7715
Provider Enumeration Date:
01/08/2024