Provider First Line Business Practice Location Address:
405 S MAIN 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:
18504-2266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-6555
Provider Business Practice Location Address Fax Number:
570-344-2699
Provider Enumeration Date:
08/04/2005