Provider First Line Business Practice Location Address:
2 PARK 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:
17901-3827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-7920
Provider Business Practice Location Address Fax Number:
570-622-9271
Provider Enumeration Date:
12/21/2006