Provider First Line Business Practice Location Address:
675 BALTIMORE DRIVE
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:
18702-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-808-6400
Provider Business Practice Location Address Fax Number:
570-808-6338
Provider Enumeration Date:
08/08/2007