Provider First Line Business Practice Location Address:
677 KIDDER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES-BARRE TWP.
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-2046
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2013