Provider First Line Business Practice Location Address:
1789 NORTH KEYSER AVENUE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-2225
Provider Business Practice Location Address Fax Number:
570-558-2226
Provider Enumeration Date:
01/30/2007