Provider First Line Business Practice Location Address:
141 N CEDAR 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:
18201-5580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-497-4419
Provider Business Practice Location Address Fax Number:
570-497-4420
Provider Enumeration Date:
10/08/2009