Provider First Line Business Practice Location Address:
1092 ROUTE 315
Provider Second Line Business Practice Location Address:
STE 3
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-324-1025
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2015