Provider First Line Business Practice Location Address:
10 E SOUTH ST APT 1100
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:
18701-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-353-3900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2015