Provider First Line Business Practice Location Address:
1112B HIGHWAY 315 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:
18702-6943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-413-0110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2025