Provider First Line Business Practice Location Address:
1320 N CHURCH 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:
18202-9367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-459-5090
Provider Business Practice Location Address Fax Number:
570-459-5090
Provider Enumeration Date:
01/08/2007