Provider First Line Business Practice Location Address:
909 WEST 15TH STREET
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:
570-450-9909
Provider Business Practice Location Address Fax Number:
570-450-6681
Provider Enumeration Date:
06/13/2006