Provider First Line Business Practice Location Address:
100 N. WILKES BARRE BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR, STE 207
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-5253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-883-5700
Provider Business Practice Location Address Fax Number:
570-883-7017
Provider Enumeration Date:
07/10/2006