Provider First Line Business Practice Location Address:
1023 QUINCY 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:
18510-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-279-7749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2009