Provider First Line Business Practice Location Address:
60 S MAIN ST
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:
18701-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-902-4113
Provider Business Practice Location Address Fax Number:
570-735-1308
Provider Enumeration Date:
11/13/2024