Provider First Line Business Practice Location Address:
10 W CHESTNUT ST
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-6423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-501-2941
Provider Business Practice Location Address Fax Number:
570-501-1194
Provider Enumeration Date:
04/18/2008