Provider First Line Business Practice Location Address:
3264 CEDAR 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:
18505-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-903-1920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2009