Provider First Line Business Practice Location Address:
75 AIRPORT ROAD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-9541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-1444
Provider Business Practice Location Address Fax Number:
570-454-1435
Provider Enumeration Date:
05/05/2006