Provider First Line Business Practice Location Address:
71 W NORTHAMPTON 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:
18701-1112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-5137
Provider Business Practice Location Address Fax Number:
570-824-4210
Provider Enumeration Date:
03/22/2011