Provider First Line Business Practice Location Address:
31 WEST MARKET 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-5144
Provider Business Practice Location Address Fax Number:
570-829-5054
Provider Enumeration Date:
01/04/2007