Provider First Line Business Practice Location Address:
702 E NORTHAMPTON 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:
18702-7517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-7216
Provider Business Practice Location Address Fax Number:
570-970-0318
Provider Enumeration Date:
03/30/2007