Provider First Line Business Practice Location Address:
1155 RTE. 315
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:
18702-6928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-820-3320
Provider Business Practice Location Address Fax Number:
570-820-3388
Provider Enumeration Date:
01/15/2008