Provider First Line Business Practice Location Address:
700 SCHUYLKILL MANOR RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-3849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-5672
Provider Business Practice Location Address Fax Number:
570-622-6099
Provider Enumeration Date:
08/16/2006