Provider First Line Business Practice Location Address:
315 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:
17901-4066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-795-9560
Provider Business Practice Location Address Fax Number:
570-516-9145
Provider Enumeration Date:
01/12/2015