Provider First Line Business Practice Location Address:
1000 W 27TH 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:
18202-9604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-813-2000
Provider Business Practice Location Address Fax Number:
856-813-2020
Provider Enumeration Date:
03/22/2007