Provider First Line Business Practice Location Address:
147 1/2 AMBER LN
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:
18702-6545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-1277
Provider Business Practice Location Address Fax Number:
570-825-1278
Provider Enumeration Date:
12/04/2006