Provider First Line Business Practice Location Address:
700 E BROAD 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:
18201-6835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-663-5910
Provider Business Practice Location Address Fax Number:
215-379-8458
Provider Enumeration Date:
08/15/2006