Provider First Line Business Practice Location Address:
22 E END CTR
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:
18702-6968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-270-6525
Provider Business Practice Location Address Fax Number:
570-270-6527
Provider Enumeration Date:
01/24/2006