Provider First Line Business Practice Location Address:
700 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:
18201-6835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-647-8990
Provider Business Practice Location Address Fax Number:
570-390-4389
Provider Enumeration Date:
08/19/2015