Provider First Line Business Practice Location Address:
1565 FAIR RD
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:
17972-9070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-754-7887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2014