Provider First Line Business Practice Location Address:
20 N LAUREL ST
Provider Second Line Business Practice Location Address:
SUITE 2-C
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-5948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-9600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2012