Provider First Line Business Practice Location Address:
396 S CENTRE ST STE 3
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:
17901-3597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-285-5097
Provider Business Practice Location Address Fax Number:
570-516-9344
Provider Enumeration Date:
12/18/2023