Provider First Line Business Practice Location Address:
437 N CENTRE 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:
17901-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-728-2600
Provider Business Practice Location Address Fax Number:
570-728-2601
Provider Enumeration Date:
09/26/2025