Provider First Line Business Practice Location Address:
24 N MAIN STREET
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:
18701-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-4140
Provider Business Practice Location Address Fax Number:
570-822-0282
Provider Enumeration Date:
03/05/2008