Provider First Line Business Practice Location Address:
836 N WASHINGTON 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:
18705-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-7002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2013