Provider First Line Business Practice Location Address:
8 WEST BROAD STREET
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-501-1334
Provider Business Practice Location Address Fax Number:
570-270-6175
Provider Enumeration Date:
06/05/2006