Provider First Line Business Practice Location Address:
159 SIMPSON 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:
18702-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-829-2613
Provider Business Practice Location Address Fax Number:
570-829-5166
Provider Enumeration Date:
04/03/2007