Provider First Line Business Practice Location Address:
1140 PA-315
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:
18711
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:
Provider Enumeration Date:
10/20/2023