Provider First Line Business Practice Location Address:
75 KIWANIS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-1157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-8511
Provider Business Practice Location Address Fax Number:
570-455-4526
Provider Enumeration Date:
03/01/2013