Provider First Line Business Practice Location Address:
700 QUINCY 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:
18510-1798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-519-0457
Provider Business Practice Location Address Fax Number:
570-340-3448
Provider Enumeration Date:
03/16/2007