Provider First Line Business Practice Location Address:
216 N RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-9722
Provider Business Practice Location Address Fax Number:
570-825-9723
Provider Enumeration Date:
03/12/2007