Provider First Line Business Practice Location Address:
545 N RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-3089
Provider Business Practice Location Address Fax Number:
570-822-0795
Provider Enumeration Date:
11/01/2006