Provider First Line Business Practice Location Address:
1159 LOOMIS 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:
18504-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-668-2438
Provider Business Practice Location Address Fax Number:
615-668-2438
Provider Enumeration Date:
11/03/2017