Provider First Line Business Practice Location Address:
558 NORTH CHURCH ST. SUITE 20
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:
18201-3188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-459-5030
Provider Business Practice Location Address Fax Number:
570-459-5022
Provider Enumeration Date:
05/18/2007