Provider First Line Business Practice Location Address:
150 MUNDY 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:
18702-6830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-3800
Provider Business Practice Location Address Fax Number:
570-826-9108
Provider Enumeration Date:
07/07/2005