Provider First Line Business Practice Location Address:
111 N FRANKLIN 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:
18701-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-0999
Provider Business Practice Location Address Fax Number:
570-208-0603
Provider Enumeration Date:
10/27/2006