Provider First Line Business Practice Location Address:
98 SOUTH CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZELTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-6226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-346-7760
Provider Business Practice Location Address Fax Number:
570-344-2071
Provider Enumeration Date:
10/17/2018