Provider First Line Business Practice Location Address:
84 W SOUTH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-388-0888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2023