Provider First Line Business Practice Location Address:
20 EAST BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HAZELTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-8800
Provider Business Practice Location Address Fax Number:
570-455-1561
Provider Enumeration Date:
11/29/2006