Provider First Line Business Practice Location Address:
58-60 PUBLIC SQUARE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-849-6037
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2019