Provider First Line Business Practice Location Address:
25 CHURCH STREET
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:
18765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-214-9763
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007