Provider First Line Business Practice Location Address:
48 TUNNEL RD STE 104
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:
17901-3875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-5455
Provider Business Practice Location Address Fax Number:
570-622-6047
Provider Enumeration Date:
11/21/2016