Provider First Line Business Practice Location Address:
730 S MAIN 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:
18711-0376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-7276
Provider Business Practice Location Address Fax Number:
570-820-3737
Provider Enumeration Date:
06/10/2006