Provider First Line Business Practice Location Address:
128 WEST 14TH 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:
18201-3266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-7677
Provider Business Practice Location Address Fax Number:
570-455-7627
Provider Enumeration Date:
02/12/2007