Provider First Line Business Practice Location Address:
1500 E 36TH 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:
18202-9394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-1400
Provider Business Practice Location Address Fax Number:
570-454-2144
Provider Enumeration Date:
11/13/2006