Provider First Line Business Practice Location Address:
1555 EAST END BLVD
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:
18711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-408-8800
Provider Business Practice Location Address Fax Number:
570-822-6076
Provider Enumeration Date:
02/27/2013