Provider First Line Business Practice Location Address:
400 W 23RD 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:
18202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-6000
Provider Business Practice Location Address Fax Number:
570-455-7371
Provider Enumeration Date:
10/26/2006