Provider First Line Business Practice Location Address:
189 E MARKET 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:
18702-5243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-846-2720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2013