Provider First Line Business Practice Location Address:
991 E CHESTNUT 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-8980
Provider Business Practice Location Address Fax Number:
570-454-0722
Provider Enumeration Date:
08/24/2006