Provider First Line Business Practice Location Address:
301 COLUMBIA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHUYLKILL HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17972-0097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-385-2322
Provider Business Practice Location Address Fax Number:
570-385-7246
Provider Enumeration Date:
01/10/2011