Provider First Line Business Practice Location Address:
14 SOUTH CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-6275
Provider Business Practice Location Address Fax Number:
570-455-6276
Provider Enumeration Date:
08/24/2006