Provider First Line Business Practice Location Address:
100 E UNION ST
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:
17901-3519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-8903
Provider Business Practice Location Address Fax Number:
570-622-8037
Provider Enumeration Date:
03/10/2006