Provider First Line Business Practice Location Address:
335 S 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:
18702-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-6425
Provider Business Practice Location Address Fax Number:
570-762-9011
Provider Enumeration Date:
07/16/2015