Provider First Line Business Practice Location Address:
440 N RIVER ST
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:
18702-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-5611
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007