Provider First Line Business Practice Location Address:
1155 HIGHWAY 315 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:
18702-6928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-235-1667
Provider Business Practice Location Address Fax Number:
570-235-1667
Provider Enumeration Date:
02/10/2026