Provider First Line Business Practice Location Address:
1201B N CHURCH ST STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZLE TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-6242
Provider Business Practice Location Address Fax Number:
570-455-8393
Provider Enumeration Date:
12/04/2020