Provider First Line Business Practice Location Address:
545 N RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-0526
Provider Business Practice Location Address Fax Number:
570-824-0688
Provider Enumeration Date:
02/20/2009