Provider First Line Business Practice Location Address:
1000 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:
18201-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-450-7272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2022