Provider First Line Business Practice Location Address:
93 WEST ST MARY'S ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES-BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-3746
Provider Business Practice Location Address Fax Number:
570-522-3746
Provider Enumeration Date:
12/06/2006