Provider First Line Business Practice Location Address:
22 E END CTR
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:
18702-6968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-9070
Provider Business Practice Location Address Fax Number:
570-208-9075
Provider Enumeration Date:
05/15/2006