Provider First Line Business Practice Location Address:
142 MUNDY 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:
18702-6875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-270-5712
Provider Business Practice Location Address Fax Number:
570-270-2015
Provider Enumeration Date:
12/03/2013