Provider First Line Business Practice Location Address:
449 E MOUNTAIN RIDGE MHP
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:
18702-8037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-498-1234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2013