Provider First Line Business Practice Location Address:
106 S CLAUDE A LORD BLVD
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:
17901-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-728-2424
Provider Business Practice Location Address Fax Number:
570-728-2425
Provider Enumeration Date:
06/29/2007