Provider First Line Business Practice Location Address:
41 S MAIN 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:
18701-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-846-4777
Provider Business Practice Location Address Fax Number:
570-846-4785
Provider Enumeration Date:
08/25/2020