Provider First Line Business Practice Location Address:
1100 HIGHWAY 315
Provider Second Line Business Practice Location Address:
PLAZA 315
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-208-1111
Provider Business Practice Location Address Fax Number:
570-270-4625
Provider Enumeration Date:
12/15/2005