Provider First Line Business Practice Location Address:
200 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:
18202-9759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-956-8149
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2016