Provider First Line Business Practice Location Address:
512 W MARKET 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:
17901-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-9990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2011