Provider First Line Business Practice Location Address:
1720 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:
570-455-3391
Provider Business Practice Location Address Fax Number:
570-455-9150
Provider Enumeration Date:
07/23/2006