Provider First Line Business Practice Location Address:
1201 N CHURCH ST # A
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-1453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-2227
Provider Business Practice Location Address Fax Number:
570-455-0227
Provider Enumeration Date:
02/15/2006