Provider First Line Business Practice Location Address:
592 S. MAIN STREET
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:
18701-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-808-4780
Provider Business Practice Location Address Fax Number:
570-808-4781
Provider Enumeration Date:
05/28/2006