Provider First Line Business Practice Location Address:
175 S WILKES BARRE 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:
18702-5040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-829-2621
Provider Business Practice Location Address Fax Number:
570-823-4332
Provider Enumeration Date:
08/15/2005