Provider First Line Business Practice Location Address:
125 MAYOCK 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:
18705-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-262-2459
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2026