Provider First Line Business Practice Location Address:
214 W WALNUT ST
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:
18201-6223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-1521
Provider Business Practice Location Address Fax Number:
570-455-2707
Provider Enumeration Date:
10/03/2014