Provider First Line Business Practice Location Address:
1551 EAST END BLVD. PLAINS TWP.
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:
18711-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-1011
Provider Business Practice Location Address Fax Number:
570-825-1211
Provider Enumeration Date:
10/19/2006