Provider First Line Business Practice Location Address:
20 DIANA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-790-2260
Provider Business Practice Location Address Fax Number:
570-790-2277
Provider Enumeration Date:
09/01/2020