Provider First Line Business Practice Location Address:
16 S CENTRE 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:
17901-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-628-5234
Provider Business Practice Location Address Fax Number:
570-628-9051
Provider Enumeration Date:
12/13/2005