Provider First Line Business Practice Location Address:
371 N WASHINGTON ST
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:
18705-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-913-4278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2017