Provider First Line Business Practice Location Address:
1402 LAUREL BLVD STE B
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:
17901-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-628-2611
Provider Business Practice Location Address Fax Number:
570-628-2616
Provider Enumeration Date:
08/01/2022