Provider First Line Business Practice Location Address:
367 E SOUTH 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:
18702-6314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-240-1660
Provider Business Practice Location Address Fax Number:
561-207-7765
Provider Enumeration Date:
07/29/2016