Provider First Line Business Practice Location Address:
133 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:
18711-0800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-5900
Provider Business Practice Location Address Fax Number:
570-208-5988
Provider Enumeration Date:
05/03/2010