Provider First Line Business Practice Location Address:
415 N MAIN ST
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:
18702-4411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-5525
Provider Business Practice Location Address Fax Number:
570-208-5548
Provider Enumeration Date:
04/03/2007