Provider First Line Business Practice Location Address:
VALLEY MEDICAL BUILDING, 3RD FLOOR
Provider Second Line Business Practice Location Address:
1010 EAST MOUNTAIN BOULEVARD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-4566
Provider Business Practice Location Address Fax Number:
570-270-5151
Provider Enumeration Date:
09/21/2006