Provider First Line Business Practice Location Address:
133 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:
18701-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-780-4233
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2016