Provider First Line Business Practice Location Address:
225 W OAK 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:
18201-5838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-599-9047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2026