Provider First Line Business Practice Location Address:
100 W ROSS 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:
18701-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-254-0794
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2025