Provider First Line Business Practice Location Address:
145 W BROAD ST
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:
18201-6317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-459-1748
Provider Business Practice Location Address Fax Number:
570-489-1749
Provider Enumeration Date:
01/31/2011