Provider First Line Business Practice Location Address:
700 EAST NORWEGIAN STREET
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:
17901-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-621-4656
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2010