Provider First Line Business Practice Location Address:
308 W 36TH ST STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZLE TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-497-4766
Provider Business Practice Location Address Fax Number:
570-245-3899
Provider Enumeration Date:
11/02/2010