Provider First Line Business Practice Location Address:
601 S POPLAR ST STE 4
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:
18201-7707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-2200
Provider Business Practice Location Address Fax Number:
570-455-2201
Provider Enumeration Date:
01/11/2018