Provider First Line Business Practice Location Address:
3 W OLIVE ST STE 206
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:
18508-2574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-800-5557
Provider Business Practice Location Address Fax Number:
570-800-5554
Provider Enumeration Date:
01/10/2012