Provider First Line Business Practice Location Address:
213 E MARKET ST
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:
18702-5234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-9645
Provider Business Practice Location Address Fax Number:
570-822-6477
Provider Enumeration Date:
04/13/2006