Provider First Line Business Practice Location Address:
34 WYOMING VALLEY MALL
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:
18702-6810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-5900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2006