Provider First Line Business Practice Location Address:
312 WILKES BARRE TOWNSHIP 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:
18702-6708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-5311
Provider Business Practice Location Address Fax Number:
512-858-2714
Provider Enumeration Date:
12/30/2014