Provider First Line Business Practice Location Address:
529 HILLSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZLE TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-2858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-3052
Provider Business Practice Location Address Fax Number:
570-453-3176
Provider Enumeration Date:
12/26/2013