Provider First Line Business Practice Location Address:
7290 FAIRLANE VILLAGE MALL
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:
17901-4105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-628-4707
Provider Business Practice Location Address Fax Number:
570-628-5790
Provider Enumeration Date:
04/10/2026