Provider First Line Business Practice Location Address:
47 SOUTH WASHINGTON ST.
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:
18701-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-824-8971
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007