Provider First Line Business Practice Location Address:
217 E 9TH ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-453-2555
Provider Business Practice Location Address Fax Number:
570-453-1043
Provider Enumeration Date:
06/30/2005