Provider First Line Business Practice Location Address:
1000 ALLIANCE DR STE 10
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:
18202-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-501-6450
Provider Business Practice Location Address Fax Number:
570-501-6436
Provider Enumeration Date:
07/03/2006