Provider First Line Business Practice Location Address:
101 W BROAD STREET
Provider Second Line Business Practice Location Address:
SUITE 412 413
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:
570-454-0334
Provider Business Practice Location Address Fax Number:
570-454-2534
Provider Enumeration Date:
03/09/2007