Provider First Line Business Practice Location Address:
2150 WILKES BARRE TOWNSHIP MARKET PL
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:
18702-6059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-821-6190
Provider Business Practice Location Address Fax Number:
570-821-6192
Provider Enumeration Date:
03/03/2010