Provider First Line Business Practice Location Address:
1335 HIGHWAY 315
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WILKES-BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-7007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-445-9214
Provider Business Practice Location Address Fax Number:
570-550-9907
Provider Enumeration Date:
05/06/2020