Provider First Line Business Practice Location Address: 
401-403 HAZLE TOWNSHIP BOULEVARD
    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: 
18202-9604
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
570-454-8888
    Provider Business Practice Location Address Fax Number: 
570-454-4190
    Provider Enumeration Date: 
12/11/2014