Provider First Line Business Practice Location Address:
991 E CHESTNUT 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:
18201-6807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-1860
Provider Business Practice Location Address Fax Number:
570-454-1898
Provider Enumeration Date:
06/14/2006