Provider First Line Business Practice Location Address:
1122 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-5161
Provider Business Practice Location Address Fax Number:
570-820-3930
Provider Enumeration Date:
01/07/2010