Provider First Line Business Practice Location Address:
59 W JUNIPER 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:
18201-6410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-497-4970
Provider Business Practice Location Address Fax Number:
570-497-4975
Provider Enumeration Date:
04/19/2021