Provider First Line Business Practice Location Address:
538 SPRUCE ST
Provider Second Line Business Practice Location Address:
SUITE 710
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18503-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-878-9714
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2012