Provider First Line Business Practice Location Address:
1383 POTTSVILLE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOEMAKERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19555-1721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-581-0216
Provider Business Practice Location Address Fax Number:
484-575-9213
Provider Enumeration Date:
10/05/2012