Provider First Line Business Practice Location Address:
268 HIGHLAND PARK BLVD
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:
18702-6768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-8831
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2017