Provider First Line Business Practice Location Address:
10 W NORTHAMPTON ST
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18701-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-714-1800
Provider Business Practice Location Address Fax Number:
570-714-1818
Provider Enumeration Date:
07/20/2006