Provider First Line Business Practice Location Address:
2040 W END AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-7291
Provider Business Practice Location Address Fax Number:
570-622-6011
Provider Enumeration Date:
11/01/2006