Provider First Line Business Practice Location Address:
16 S RIVER ST FL 3
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:
18702-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-599-5160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2025