Provider First Line Business Practice Location Address:
64 SOUTH LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZELTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-5521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2006