Provider First Line Business Practice Location Address:
1189 HIGHWAY 315
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
WILKES-BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-883-9022
Provider Business Practice Location Address Fax Number:
570-883-7497
Provider Enumeration Date:
05/28/2006