Provider First Line Business Practice Location Address:
1111 EAST END BOULVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKESBARRE
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:
570-824-3521
Provider Business Practice Location Address Fax Number:
570-819-5176
Provider Enumeration Date:
09/06/2006