Provider First Line Business Practice Location Address:
121 AIRPORT RD
Provider Second Line Business Practice Location Address:
100 LAUREL PROF. BLDG.
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-3355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-5101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2006