Provider First Line Business Practice Location Address:
1777 NORTH KEYSER AVENUE
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:
18508-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-346-2087
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2006