Provider First Line Business Practice Location Address:
21 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:
17901-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
272-224-1604
Provider Business Practice Location Address Fax Number:
570-628-5298
Provider Enumeration Date:
04/20/2007