Provider First Line Business Practice Location Address:
329 CHERRY ST
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:
18505-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-649-6493
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2022