Provider First Line Business Practice Location Address:
23 FAITH DR
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:
18202-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-501-9814
Provider Business Practice Location Address Fax Number:
570-455-2240
Provider Enumeration Date:
11/11/2011