Provider First Line Business Practice Location Address:
29 BEAR CREEK BLVD
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:
18702-7803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-550-0893
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2015