Provider First Line Business Practice Location Address:
112 HAVERFORD DR
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:
18702-7207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-479-2066
Provider Business Practice Location Address Fax Number:
570-655-5934
Provider Enumeration Date:
06/19/2009