Provider First Line Business Practice Location Address:
601 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-1100
Provider Business Practice Location Address Fax Number:
570-455-1101
Provider Enumeration Date:
11/13/2015