Provider First Line Business Practice Location Address:
115 MEADOW 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:
18505-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-346-4010
Provider Business Practice Location Address Fax Number:
570-346-8436
Provider Enumeration Date:
02/21/2007