Provider First Line Business Practice Location Address:
631 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:
18505-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-346-6203
Provider Business Practice Location Address Fax Number:
570-346-3060
Provider Enumeration Date:
03/06/2014