Provider First Line Business Practice Location Address:
545 KIEFER AVE
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:
18201-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-459-5615
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2011