Provider First Line Business Practice Location Address:
1807 LUZERNE ST APT 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:
18504-2387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-785-3226
Provider Business Practice Location Address Fax Number:
570-785-2369
Provider Enumeration Date:
05/25/2026