Provider First Line Business Practice Location Address:
545 N RIVER 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:
18702-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-706-2620
Provider Business Practice Location Address Fax Number:
570-706-2627
Provider Enumeration Date:
02/06/2020