Provider First Line Business Practice Location Address:
1003 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:
18504-9728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-7663
Provider Business Practice Location Address Fax Number:
570-343-7664
Provider Enumeration Date:
09/17/2021