Provider First Line Business Practice Location Address:
200 E ARCH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-2982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-0809
Provider Business Practice Location Address Fax Number:
570-628-5080
Provider Enumeration Date:
05/28/2007