Provider First Line Business Practice Location Address:
1053 N CHURCH 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:
18202-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-7486
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2007