Provider First Line Business Practice Location Address:
1506 ROUTE 61 HWY S
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:
17901-8409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-9882
Provider Business Practice Location Address Fax Number:
855-223-6216
Provider Enumeration Date:
11/16/2007