Provider First Line Business Practice Location Address:
930 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:
18510-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-322-8384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2014