Provider First Line Business Practice Location Address:
1000 EAST MOUTAIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18711-4903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-808-7850
Provider Business Practice Location Address Fax Number:
570-808-7855
Provider Enumeration Date:
05/03/2007