Provider First Line Business Practice Location Address:
668 N CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-3194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-450-6454
Provider Business Practice Location Address Fax Number:
570-450-2048
Provider Enumeration Date:
10/24/2006