Provider First Line Business Practice Location Address:
545 N RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-6616
Provider Business Practice Location Address Fax Number:
570-288-6860
Provider Enumeration Date:
06/18/2006