Provider First Line Business Practice Location Address:
8 CHURCH ST STE 216
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:
18702-3539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-821-7391
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006