Provider First Line Business Practice Location Address:
223 ROUTE 61 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHUYLKILL HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17972-9704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-8450
Provider Business Practice Location Address Fax Number:
570-385-8451
Provider Enumeration Date:
06/08/2009