Provider First Line Business Practice Location Address:
328 SCOTT 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:
18702-5535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-824-9811
Provider Business Practice Location Address Fax Number:
570-821-4519
Provider Enumeration Date:
05/31/2005