Provider First Line Business Practice Location Address:
400 WLKES BAR TWP 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:
18702-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-235-2001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2009