Provider First Line Business Practice Location Address:
191 MANHEIM RD
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:
17972-9757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-8227
Provider Business Practice Location Address Fax Number:
570-385-8272
Provider Enumeration Date:
07/07/2005