Provider First Line Business Practice Location Address:
1550 HIGHWAY 315 BLVD STE 104
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:
18702-7121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-760-7018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2013