Provider First Line Business Practice Location Address:
1725 CEDAR AVE REAR
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:
18505-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-907-0016
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2007