Provider First Line Business Practice Location Address:
1324 N CHURCH ST
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:
18202-9307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-501-1808
Provider Business Practice Location Address Fax Number:
855-635-6308
Provider Enumeration Date:
11/13/2013