Provider First Line Business Practice Location Address:
45 E NORTHAMPTON ST STE 101
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:
18701-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-820-4470
Provider Business Practice Location Address Fax Number:
484-328-6377
Provider Enumeration Date:
04/06/2023