Provider First Line Business Practice Location Address:
264 HIGHLAND PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-824-0023
Provider Business Practice Location Address Fax Number:
570-824-1666
Provider Enumeration Date:
09/16/2005