Provider First Line Business Practice Location Address:
2200 1ST 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:
17901-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-628-6950
Provider Business Practice Location Address Fax Number:
570-628-4874
Provider Enumeration Date:
09/13/2010