Provider First Line Business Practice Location Address:
125 N WILKES BARRE BLVD
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:
18702-5354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-4858
Provider Business Practice Location Address Fax Number:
570-208-4874
Provider Enumeration Date:
06/07/2018