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:
570-552-4450
Provider Business Practice Location Address Fax Number:
570-552-4455
Provider Enumeration Date:
01/04/2016