Provider First Line Business Practice Location Address:
1782 N KEYSER 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:
18508-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-207-4308
Provider Business Practice Location Address Fax Number:
570-207-9853
Provider Enumeration Date:
11/01/2011