Provider First Line Business Practice Location Address:
71 N FRANKLIN 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:
18701-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-829-2453
Provider Business Practice Location Address Fax Number:
570-829-2462
Provider Enumeration Date:
01/24/2007