Provider First Line Business Practice Location Address:
1730 E BROAD 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:
18201-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-9589
Provider Business Practice Location Address Fax Number:
570-455-8848
Provider Enumeration Date:
04/03/2006