Provider First Line Business Practice Location Address:
811 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:
18510-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-2231
Provider Business Practice Location Address Fax Number:
570-342-2231
Provider Enumeration Date:
12/21/2006