Provider First Line Business Practice Location Address:
101 MILL CREEK AVE
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:
17901-8668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-6732
Provider Business Practice Location Address Fax Number:
570-628-3899
Provider Enumeration Date:
03/21/2007