Provider First Line Business Practice Location Address:
321 BERNER 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:
18201-7472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-4699
Provider Business Practice Location Address Fax Number:
570-455-3296
Provider Enumeration Date:
07/08/2006