Provider First Line Business Practice Location Address:
34 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18701-1734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-0187
Provider Business Practice Location Address Fax Number:
570-823-0188
Provider Enumeration Date:
06/15/2006