Provider First Line Business Practice Location Address:
401 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:
17901-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-2036
Provider Business Practice Location Address Fax Number:
570-622-5242
Provider Enumeration Date:
02/01/2006