Provider First Line Business Practice Location Address:
1086 HIGHWAY 315 BLVD
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:
18702-7012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-846-1025
Provider Business Practice Location Address Fax Number:
570-904-8571
Provider Enumeration Date:
05/28/2020