Provider First Line Business Practice Location Address:
910 WILKES-BARRE TWP. BLVD.
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:
18702-6194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-954-1884
Provider Business Practice Location Address Fax Number:
847-747-1479
Provider Enumeration Date:
02/25/2010