Provider First Line Business Practice Location Address:
1111 E END BLVD
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:
18711-0030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-824-3521
Provider Business Practice Location Address Fax Number:
570-819-5173
Provider Enumeration Date:
08/11/2006