Provider First Line Business Practice Location Address:
50 ROOSEVELT TER
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:
18702-3517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-808-8780
Provider Business Practice Location Address Fax Number:
570-808-8785
Provider Enumeration Date:
02/24/2006