Provider First Line Business Practice Location Address:
1140 HIGHWAY 315
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18711-0911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-970-0402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2012