Provider First Line Business Practice Location Address:
467 E 17TH ST
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:
18201-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2011