Provider First Line Business Practice Location Address:
603 W MARKET 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:
17901-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-628-4731
Provider Business Practice Location Address Fax Number:
570-516-9448
Provider Enumeration Date:
12/23/2005