Provider First Line Business Practice Location Address:
111 LILLY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHUYLKILL HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17972-1153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-1190
Provider Business Practice Location Address Fax Number:
570-385-1190
Provider Enumeration Date:
11/13/2007