Provider First Line Business Practice Location Address:
1090 N CHURCH ST
Provider Second Line Business Practice Location Address:
200 HAZLETON PROFESSIONAL PLAZA
Provider Business Practice Location Address City Name:
HAZLE TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-1480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-0100
Provider Business Practice Location Address Fax Number:
570-455-0177
Provider Enumeration Date:
04/19/2017