Provider First Line Business Practice Location Address:
78 NORTH CHURCH STREET
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:
18201-5802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-459-6666
Provider Business Practice Location Address Fax Number:
570-459-5386
Provider Enumeration Date:
08/09/2005