Provider First Line Business Practice Location Address:
1730 EAST BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HAZELTON
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:
570-459-2226
Provider Business Practice Location Address Fax Number:
570-459-2511
Provider Enumeration Date:
07/12/2006