Provider First Line Business Practice Location Address:
180 S WASHINGTON ST APT 101N
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:
18701-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-350-8383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2022