Provider First Line Business Practice Location Address:
1140 ROUTE 315
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WILKES BARRE TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-451-3404
Provider Business Practice Location Address Fax Number:
570-451-3407
Provider Enumeration Date:
12/12/2025