Provider First Line Business Practice Location Address:
465 E CHESTNUT 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:
570-455-7223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006