Provider First Line Business Practice Location Address:
101 PITTSTON AVE STE 3
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:
18505-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-5444
Provider Business Practice Location Address Fax Number:
570-342-5539
Provider Enumeration Date:
06/17/2020