Provider First Line Business Practice Location Address:
548 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:
18702-6112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-6994
Provider Business Practice Location Address Fax Number:
570-821-5766
Provider Enumeration Date:
08/13/2019