Provider First Line Business Practice Location Address:
1000 EAST MOUNTAIN BLVD
Provider Second Line Business Practice Location Address:
MC: 37-62
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:
570-808-2340
Provider Business Practice Location Address Fax Number:
570-808-7904
Provider Enumeration Date:
06/22/2010