Provider First Line Business Practice Location Address:
255 WEST DIAMOND AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-0783
Provider Business Practice Location Address Fax Number:
570-454-4609
Provider Enumeration Date:
02/21/2007