Provider First Line Business Practice Location Address:
1816 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:
17901-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-628-9448
Provider Business Practice Location Address Fax Number:
570-628-9445
Provider Enumeration Date:
08/21/2009