Provider First Line Business Practice Location Address:
111 S CENTRE 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:
17901-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-628-6858
Provider Business Practice Location Address Fax Number:
570-628-4054
Provider Enumeration Date:
01/26/2006