Provider First Line Business Practice Location Address:
1840 W END AVE
Provider Second Line Business Practice Location Address:
3
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-573-4136
Provider Business Practice Location Address Fax Number:
570-622-9862
Provider Enumeration Date:
01/21/2011