Provider First Line Business Practice Location Address:
679 KIDDER ST
Provider Second Line Business Practice Location Address:
STORE # 8
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-704-0300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2021