Provider First Line Business Practice Location Address:
3400 WILKES BARRE TOWNSHIP CMNS
Provider Second Line Business Practice Location Address:
T-1845
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-829-4983
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2011