Provider First Line Business Practice Location Address:
396 S CENTRE ST
Provider Second Line Business Practice Location Address:
THIRD FLOOR
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-3596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-573-0247
Provider Business Practice Location Address Fax Number:
570-621-9888
Provider Enumeration Date:
07/06/2006