Provider First Line Business Practice Location Address:
268 HIGHLAND PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-8831
Provider Business Practice Location Address Fax Number:
570-820-7740
Provider Enumeration Date:
08/31/2006