Provider First Line Business Practice Location Address:
1515 W 23RD 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:
18202-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-459-3111
Provider Business Practice Location Address Fax Number:
570-459-3211
Provider Enumeration Date:
05/17/2006