Provider First Line Business Practice Location Address:
929 CEDAR 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:
18505-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-955-3260
Provider Business Practice Location Address Fax Number:
570-504-7278
Provider Enumeration Date:
06/13/2011