Provider First Line Business Practice Location Address:
307 LAIRD ST. REAR
Provider Second Line Business Practice Location Address:
CHOICES PROGRAM OF WYOMING VALLEY
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:
570-408-9320
Provider Business Practice Location Address Fax Number:
570-408-9324
Provider Enumeration Date:
10/17/2011