Provider First Line Business Practice Location Address:
19 KIDDER 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:
18702-5416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-832-5964
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2013