Provider First Line Business Practice Location Address:
15 PUBLIC SQ
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18701-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-1777
Provider Business Practice Location Address Fax Number:
570-823-3040
Provider Enumeration Date:
10/07/2022