Provider First Line Business Practice Location Address:
299 S MAIN 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:
18701-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-0654
Provider Business Practice Location Address Fax Number:
570-270-0449
Provider Enumeration Date:
03/16/2007