Provider First Line Business Practice Location Address:
1789 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:
18508-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-969-1904
Provider Business Practice Location Address Fax Number:
570-207-5314
Provider Enumeration Date:
09/27/2012