Provider First Line Business Practice Location Address:
545 N RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-270-4455
Provider Business Practice Location Address Fax Number:
570-270-4884
Provider Enumeration Date:
09/22/2006