Provider First Line Business Practice Location Address:
620 BALTIMORE DR
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:
18702-7959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-4721
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2021