Provider First Line Business Practice Location Address:
82 S 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:
18701-3029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-0290
Provider Business Practice Location Address Fax Number:
570-823-8511
Provider Enumeration Date:
07/11/2006