Provider First Line Business Practice Location Address:
20 N LAUREL ST STE 2A
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:
18201-5948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-459-0029
Provider Business Practice Location Address Fax Number:
570-454-5757
Provider Enumeration Date:
01/17/2007