Provider First Line Business Practice Location Address:
575 E MAIN 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:
18702-6944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-270-5050
Provider Business Practice Location Address Fax Number:
570-270-5550
Provider Enumeration Date:
07/10/2006