Provider First Line Business Practice Location Address:
50 MOISEY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-9296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-501-6610
Provider Business Practice Location Address Fax Number:
570-501-6624
Provider Enumeration Date:
08/27/2007