Provider First Line Business Practice Location Address:
1086 HIGHWAY 315 BLVD
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:
18702-7012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-7761
Provider Business Practice Location Address Fax Number:
570-829-7761
Provider Enumeration Date:
07/12/2011