Provider First Line Business Practice Location Address:
1620 HIGHWAY 315 BLVD STE 1
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:
18702-7125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-237-5444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2005