Provider First Line Business Practice Location Address:
87 EAST MAIN 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:
18705-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-821-1982
Provider Business Practice Location Address Fax Number:
570-826-6989
Provider Enumeration Date:
10/03/2006