Provider First Line Business Practice Location Address:
1130 HIGHWAY 315
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:
18702-6952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-821-2830
Provider Business Practice Location Address Fax Number:
570-823-7921
Provider Enumeration Date:
04/10/2006