Provider First Line Business Practice Location Address:
1630 MOUNT HOPE 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:
17901-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-1553
Provider Business Practice Location Address Fax Number:
570-622-3531
Provider Enumeration Date:
01/24/2006