Provider First Line Business Practice Location Address:
100 N WILKES BARRE BLVD
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-5253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-969-3338
Provider Business Practice Location Address Fax Number:
908-359-7434
Provider Enumeration Date:
07/12/2007