Provider First Line Business Practice Location Address:
SUITE 240 MEDICAL ARTS BLDG
Provider Second Line Business Practice Location Address:
35 W LINDEN STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-1111
Provider Business Practice Location Address Fax Number:
570-829-0300
Provider Enumeration Date:
08/04/2005